| NPI | 1861751034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 303003) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036.138533) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2019-04-08 |